Provider Demographics
NPI:1366824872
Name:LEE, SIHEON (LAC)
Entity Type:Individual
Prefix:
First Name:SIHEON
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 W HEDDING ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-1217
Mailing Address - Country:US
Mailing Address - Phone:408-726-6375
Mailing Address - Fax:855-856-6747
Practice Address - Street 1:1032 W HEDDING ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-1217
Practice Address - Country:US
Practice Address - Phone:408-726-6375
Practice Address - Fax:855-856-6747
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16688171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist